REQUEST FOR CHILD BAPTISM

REQUEST FOR CHILD BAPTISM

Name of Child (First, Middle, and Last) REQUIRED Please fill out this field. Please enter valid data.

Sex of Child REQUIRED Male Female Baby Not Born Yet Please fill out this field.

Date of Birth or Due Date REQUIRED Please fill out this field. Please enter valid data.

Place of Birth (Name of Hospital, City, and State) REQUIRED Please fill out this field. Please enter valid data.

Name of Father (First, Middle, Last) REQUIRED Please fill out this field. Please enter valid data.

Religion and Church of Registration of the Father REQUIRED Please fill out this field. Please enter valid data.

Is the Father of the Eastern Catholic Rite? REQUIRED Yes No Please fill out this field.

If Yes, Which Eastern Catholic Rite Please enter valid data.

Father's Church attendance is: REQUIRED Weekly Monthly Occassionly Seldom Please fill out this field.

Name of Mother (First, Middle, (Married) and MAIDEN Name) REQUIRED Please fill out this field. Please enter valid data.

Very important to Enter the "Maiden Name" of the Mother

Religion and Church of Registration of the Mother REQUIRED Please fill out this field. Please enter valid data.

Is the Mother of the Eastern Catholic Rite? REQUIRED Yes No Please fill out this field.

If Yes, Which Eastern Catholic Rite Please enter valid data.

Mother's Church attendance is: REQUIRED Weekly Monthly Occassionly Seldom Please fill out this field.

Marriage: (Name of Church, Denomination, City, State, and Date) REQUIRED Please fill out this field.

Monthly Baptism Preparation Class

Attendance at a Baptism Class is required for those who have not attended a class within the past five years.

Baptism Preparation classes are usually held on the 3rd Sunday of the month in the Parish Cafeteria from 9:15 until 10:45 am.

Please Select One of the following: REQUIRED We have attended a baptism class within the last five years Baptism Monthly Class - Feb 09, 2025 Baptism Monthly Class - Mar 16, 2025 Baptism Monthly Class - Apr 06, 2025 Baptism Monthly Class - May 18, 2025 Baptism Monthly Class - Jun 15, 2025 Baptism Monthly Class - Jul 20, 2025 Please fill out this field.

GODPARENT INFORMATION:

Name of Godfather (First, Middle, and Last) REQUIRED Please fill out this field. Please enter valid data.

Religion and Church of Registration REQUIRED Please fill out this field. Please enter valid data.

Name of Godmother (First, Middle, and Last) REQUIRED Please fill out this field. Please enter valid data.

Religion and Church of Registration REQUIRED Please fill out this field. Please enter valid data.

Names of Proxies (those standing in for the godparents, if necessary) Please enter valid data.

Religion and Church of Registration (again if necessary) Please enter valid data.

Please Provide Parent Address Information:

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Comments

Are you a member of St. Patrick Church? (If no we will need a letter of permission from the pastor of where you are registered before we can schedule the baptism) REQUIRED Yes No Please fill out this field.

Child's Birth Certificate
Beside completing this Form, please provide us a copy of your child's birth certificate either when we meet with you or by mailing it to St. Patrick Church 219 S. Beaver Street, York, Pa 17401